Medical Ethics in Providing Drug Information

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Medical Ethics in Providing Drug Information

• Jason C. Cooper, Pharm D
• Assistant Professor, Department of
• Pharmacy Practice
• Clinical Specialist, Drug Information Services

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Objectives

• Understand the terms ethics and morals.
• Describe other important ethical
  phrases and terms.
  
• Recognize eight ethically relevant considerations
  in the care of patients.
• Learn to follow a general case method for
  approaching and resolving ethical dilemmas.

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Overview

• Case presentation
• Definitions
• Ethical/moral considerations in patient care
• Ethical case method
• Conclusions

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Case Presentation

• A concerned mother phones the Drug
• Information Center and describes a tablet she
• found in her 17-year-olds dresser drawer. She
• is unaware that her son is on any prescription
• medication since she has not taken him to a
• physician recently. She begins to cry as she
  asks
• you whether or not this is an illegal substance.
• Do you tell her what it is?

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Ethics vs. Morals

• Ethics
• language from the Greek word ethos meaning
  character
• description justify, interpret, analyze
• question Why should I do X or Y?
• definition The discipline of dealing with what
  is good and bad with moral duty and obligation.

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Ethics vs. Morals

• Morals
• language from the Latin word mores meaning
  custom or habit
• description normative or prescriptive
• question What should I do in situation X or Y?
• definition relating to widely shared beliefs
  about the norms of right and wrong conduct or
  behavior

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Ethical Definitions

• Beneficence
• Doing or producing good.
• Non-maleficence
• Do no harm.

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More Ethical Definitions

• Patient autonomy
• The right of the patient to ultimately decide
  what is in his/her best interests.
• Disclosure
• Informing a patient of all relevant information
  or truthtelling.

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Even More Definitions

• Informed consent
• Patient should understand and comprehend written
  or oral information presented.
• Shared decision making
• Decision making that involves the patient and
  entire health-care team.

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Still More Definitions

• Surrogate decision making
• Decision making that involves someone other than
  the primary patient.
• Mature minor
• Individuals under 18 years of age that the court
  has determined to be capable of making his/her
  own decisions based on previous experiences.

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• THIS SPACE
• FOR RENT

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YesEven More Definitions

• Competent/Incompetent

• Court term for whether one has been
  considered able (mentally, physically) to
  manage the state of their own affairs.

• Capable/Incapable

• Relates to the ability of a patient to
  understand and comprehend information enough
  to make a rational decision for him/herself.

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Eight Considerations in the Care of Patients

• Balancing benefits and harms
• Disclosure, informed consent, shared decision
  making, respect for patient
  autonomy
• The norms of family life
• Clinician/patient relationship

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Eight Considerations in the Care of Patients

• Professional integrity
• Cost-effectiveness and allocation
• Issues of cultural and religious variation
• Considerations of power

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Four-Step Case Method to Solving Ethical Dilemmas

• Assessment
• Contextual factors
• Patients capacity
• Needs as a person/preferences
• Power issues

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Four-Step Case Method to Solving Ethical Dilemmas

• Moral diagnosis
• Framing of views
• Moral considerations
• Similar cases
• Options

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Four-Step Case Method to Solving Ethical Dilemmas

• Goals
• Interventions
• Merits of options
• Evaluation
• Current
• Retrospective

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Case Presentation

• A concerned mother phones the Drug
• Information Center and describes a tablet she
• found in her 17-year-olds dresser drawer. She
• is unaware that her son is on any prescription
• medication since she has not taken him to a
• physician recently. She begins to cry as she
  asks
• you whether or not this is an illegal substance.
• Do you tell her what it is?

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Evaluation of Case

• Assessment

• Contextual

• Mother found unknown tablet in sons dresser
  drawer

• Son is 17 years of age

• Mother suspects drug abuse

• Capacity

• 17 year-old child, parent is legal guardian

• No indication of incapacity with mother

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Evaluation of Case

• Assessment

• Needs

• Needs tablet identified (mother)

• Needs to confront son about possible drug abuse

• Underlying family issues

• Power issues

• Parent vs. child

• Clinician/patient relationship (potential)

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Evaluation of Case

• Moral Diagnosis

• Framing

• Mother son may be doing something harmful

• Son invasion of privacy

• Clinician confidentiality

• Moral considerations

• Patient confidentiality invasion of privacy

• Norms of family life

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Evaluation of Case

• Moral Diagnosis

• Moral considerations (cont.)

• Surrogate decision making (mature minor)

• Clinician/patient relationship

• Truthtelling, disclosure

• Options

• Tell her/dont tell her

• Encourage discussion with son about drug use

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Evaluation of Case

• Goals

• Interventions

• Encourage discussion with son

• Reassurance for mother

• Merits

• Upholds patient confidentiality

• Encourages family discussion of underlying
  issues

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Evaluation of Case

• Evaluation
• Current
• Current way of solving problem is not working
• Creates ethical dilemma
• Retrospective
• Policies for similar calls

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Conclusion

• Ethics apply to pharmacy
• Important to understand and apply ethical
  definitions and terms
• Eight general considerations apply to the care of
  patients
• Ethical dilemmas should be approached in a
  step-wise fashion